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Rahouma M, Baudo M, Khairallah S, Lau C, Gaudino M, El-Sayed Ahmed MM, Kumar A, Lorusso R, Mick SL. Surgically Resected Cardiac Angiosarcoma: Survival Analysis from the National Cancer Database. J Clin Med 2023; 12:7764. [PMID: 38137833 PMCID: PMC10744152 DOI: 10.3390/jcm12247764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023] Open
Abstract
Angiosarcoma is a rare type of soft-tissue sarcoma arising from endothelial cells. It is considered 'high-grade' by definition, reflecting its aggressive behavior. We sought to investigate the role of surgery in cardiac angiosarcoma, identify late mortality predictors, and identify interactions with other modalities in its treatment using a national dataset. The 2004-2017 National Cancer Database was reviewed for patients with primary cardiac angiosarcoma. Late mortality predictors were evaluated with Kaplan-Meier curves and Cox regression analysis. Surgery in primary cardiac angiosarcoma was performed in 130 patients (median age 50.5 years; female sex 36.9%). The median follow up was 72.02 months, with a median overall survival (OS) of 14.32 months. In patients treated with surgery in combination with other modalities compared with those treated with surgery alone, median OSs were 17.28 and 2.88 months, respectively (log-rank = 0.018). Older patients (age > 57 years) experienced lower OS compared to those with an age < 57 (log-rank = 0.012). This may be partially explained by the difference in treatment strategies among age groups: those with increasing age, less surgery (p = 0.037), and less chemotherapy (p < 0.001) were chosen. With multivariable Cox regression analysis, age and race other than white or black were identified to be significant independent predictors of late mortality. Cardiac angiosarcoma has poor overall survival, and our findings should further encourage the use of surgery in combination with other therapeutic modalities in treating such an aggressive disease whenever possible.
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Affiliation(s)
- Mohamed Rahouma
- Cardiothoracic Surgery Departments, Weill Cornell Medicine, New York, NY 10065, USA; (M.B.); (S.K.); (C.L.); (M.G.); (S.L.M.)
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo 12613, Egypt
| | - Massimo Baudo
- Cardiothoracic Surgery Departments, Weill Cornell Medicine, New York, NY 10065, USA; (M.B.); (S.K.); (C.L.); (M.G.); (S.L.M.)
- Cardiac Surgery Department, Spedali Civili di Brescia, University of Brescia, 25121 Brescia, Italy
| | - Sherif Khairallah
- Cardiothoracic Surgery Departments, Weill Cornell Medicine, New York, NY 10065, USA; (M.B.); (S.K.); (C.L.); (M.G.); (S.L.M.)
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo 12613, Egypt
| | - Christopher Lau
- Cardiothoracic Surgery Departments, Weill Cornell Medicine, New York, NY 10065, USA; (M.B.); (S.K.); (C.L.); (M.G.); (S.L.M.)
| | - Mario Gaudino
- Cardiothoracic Surgery Departments, Weill Cornell Medicine, New York, NY 10065, USA; (M.B.); (S.K.); (C.L.); (M.G.); (S.L.M.)
| | - Magdy M. El-Sayed Ahmed
- Cardiothoracic Surgery Department, Mayo Clinic, Jacksonville, FL 55905, USA;
- Department of Surgery, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Akshay Kumar
- Department of Cardiothoracic Surgery, Heart and Lung Transplantation, Mechanical Circulatory Support and ECMO, New York University Langone Health, New York, NY 10016, USA;
| | - Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre, Maastricht University, 6211 LK Maastricht, The Netherlands;
- Cardiovascular Research Institute Maastricht, 6229 ER Maastricht, The Netherlands
| | - Stephanie L. Mick
- Cardiothoracic Surgery Departments, Weill Cornell Medicine, New York, NY 10065, USA; (M.B.); (S.K.); (C.L.); (M.G.); (S.L.M.)
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2
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Stergioula A, Kokkali S, Pantelis E. Multimodality treatment of primary cardiac angiosarcoma: A systematic literature review. Cancer Treat Rev 2023; 120:102617. [PMID: 37603906 DOI: 10.1016/j.ctrv.2023.102617] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Primary cardiac angiosarcoma (PCA) is the most prevalent histological type of cardiac sarcoma but its rarity poses a challenge for standardizing treatment protocols. Moreover, published studies are limited by small patient numbers and lack of randomization, making it challenging to establish evidence-based treatment strategies. This systematic review aims to consolidate the heterogeneous published data and identify factors related to the treatment outcome of PCA patients. METHODS The PubMed and Scopus bibliographic databases were systematically searched for original articles reporting clinical, treatment and outcome data for PCA patients. Kaplan-Meier analysis was used to calculate the time to progression and survival. The Log-Rank test was used to compare progression-free and overall survival data. The Cox proportional hazards regression model was used for univariate and multivariate analysis of survival data. RESULTS A total of 127 studies containing data for 162 patients were analyzed. The median age of the patient cohort was 45 years, with males being 1.5 times more frequently affected than females. Tumors were primarily located on the right side of the heart, with a median size of 6 cm. Median progression-free and overall survival of 5 months and 12 months, respectively, were calculated. Age, sex, and resection margins did not have a significant impact on PCA survival, as determined by both univariate and multivariate analyses. The presence of metastases at diagnosis was associated with lower overall survival in univariate analysis, although this effect was not significant in multivariate analysis. Multimodality treatment that incorporated surgery and adjuvant chemo-radiotherapy was associated with a statistically significant survival benefit. Median overall survival increased from 6 months with surgery alone to 13 months and 27 months with adjuvant chemotherapy and chemo-radiotherapy, respectively. CONCLUSION Multimodality treatment including surgery and chemo-radiotherapy was found to offer the greatest survival benefit for PCA patients.
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Affiliation(s)
- Anastasia Stergioula
- Radiotherapy Department, Iatropolis Clinic, Athens, Greece; Center of Radiotherapy, IASO General Hospital, Athens, Greece.
| | - Stefania Kokkali
- Oncology Unit, Department of Internal Medicine, Hippocratio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Evaggelos Pantelis
- Radiotherapy Department, Iatropolis Clinic, Athens, Greece; Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Ung N, Gunasingam C, Cai K, Manolios N, Bayly A, Dinh P, Orr Y, Choudhary P, Wong P. Cardiac sarcoma presenting as paraneoplastic arthritis and clubbing: a case report and literature review. BMC Rheumatol 2023; 7:30. [PMID: 37715284 PMCID: PMC10503070 DOI: 10.1186/s41927-023-00350-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 07/31/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Cardiac tumours are rare, and clinical manifestations depend on the anatomical location. Symptoms can be the result of cardiac outflow anomalies, constitutional features such as fever, loss of weight, and/or paraneoplastic manifestations such as arthritis. To date, there has only been one other case report in the literature of cardiac sarcoma presenting as paraneoplastic arthropathy. CASE PRESENTATION A 52-year-old woman presented with acute onset corticosteroid-resistant inflammatory polyarthralgia, clubbing and a systolic murmur. Transthoracic echocardiogram revealed a dilated left atrium with an echogenic mass and brain magnetic resonance imaging revealed multiple embolic infarcts. Histopathology following emergency resection showed a Grade 3 left atrial intimal sarcoma. The polyarthralgia and clubbing resolved soon after tumour removal. The patient went on to receive chemotherapy and remains in remission. CONCLUSIONS This case highlights the rare paraneoplastic association of cardiac sarcoma and arthropathy.
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Affiliation(s)
- Natasha Ung
- Department of Rheumatology, Westmead Hospital, Cnr Hawkesbury Road and Darcy Road, Westmead, NSW, 2145, Australia
- Westmead Clinical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - Carmella Gunasingam
- Department of Rheumatology, Westmead Hospital, Cnr Hawkesbury Road and Darcy Road, Westmead, NSW, 2145, Australia
| | - Ken Cai
- Department of Rheumatology, Westmead Hospital, Cnr Hawkesbury Road and Darcy Road, Westmead, NSW, 2145, Australia
- Westmead Clinical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - Nicholas Manolios
- Department of Rheumatology, Westmead Hospital, Cnr Hawkesbury Road and Darcy Road, Westmead, NSW, 2145, Australia
- Westmead Clinical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - Angela Bayly
- Department of Tissue Pathology and Diagnostic Oncology, Westmead Hospital, Westmead, NSW, Australia
| | - Phuong Dinh
- Department of Medical Oncology, Westmead Hospital, Westmead, NSW, Australia
| | - Yishay Orr
- Westmead Clinical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, NSW, Australia
- Department of Cardiothoracic Surgery, Westmead Hospital, Westmead, NSW, Australia
| | - Preeti Choudhary
- Westmead Clinical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, NSW, Australia
- Department of Cardiology, Westmead Hospital, Westmead, NSW, Australia
| | - Peter Wong
- Department of Rheumatology, Westmead Hospital, Cnr Hawkesbury Road and Darcy Road, Westmead, NSW, 2145, Australia.
- Westmead Clinical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, NSW, Australia.
- Rural Clinical School, University of New South Wales, Coffs Harbour, NSW, Australia.
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Mubder M, Pour-Ghaz I, Al-Taweel O, Alhwarat B, Bond A, Choudhury AH, Mahmoud O, Alkhatib D. Primary Cardiac Sarcoma: Angiosarcoma Compressing the Right Coronary Artery. Cureus 2023; 15:e38360. [PMID: 37266054 PMCID: PMC10230120 DOI: 10.7759/cureus.38360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2023] [Indexed: 06/03/2023] Open
Abstract
Cardiac tumors are uncommon and can be classified as either primary benign, primary malignant, or metastatic. Cardiac tumors have a wide range of presentations, which can lead to delays in diagnosis and treatment. Primary cardiac tumors can also affect nearby structures, and there have been a few reported cases of coronary artery involvement with various underlying causes. In this case report, we describe a patient with a primary cardiac sarcoma (angiosarcoma) that had spread to other parts of the body and caused occlusion of the right coronary artery.
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Affiliation(s)
- Mohamad Mubder
- Internal Medicine, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, Las Vegas, USA
| | - Issa Pour-Ghaz
- Cardiology, The University of Tennessee Health Science Center, Memphis, USA
| | - Omar Al-Taweel
- Cardiology, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, Las Vegas, USA
| | | | - Addison Bond
- College of Medicine, The University of Tennessee Health Science Center, Memphis, USA
| | - Ahsan H Choudhury
- Cardiology, University Medical Center, Las Vegas, USA
- Cardiology, University of Nevada, Reno, USA
| | - Osama Mahmoud
- Cardiovascular Medicine, The University of Tennessee Health Science Center, Memphis, USA
| | - Deya Alkhatib
- Cardiovascular Medicine, The University of Tennessee Health Science Center, Memphis, USA
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Pino PG, Moreo A, Lestuzzi C. Differential diagnosis of cardiac tumors: General consideration and echocardiographic approach. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:1177-1193. [PMID: 36218203 PMCID: PMC9828386 DOI: 10.1002/jcu.23309] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/21/2022] [Accepted: 08/23/2022] [Indexed: 06/16/2023]
Abstract
Cardiac tumors may be primary (either benign or malignant) or secondary (malignant) and are first detected by echocardiography in most cases. The cardiologist often challenges their identification, the differential diagnosis and the best therapeutic approach. Malignant tumors have usually a poor prognosis, which may be significantly improved by appropriate and timely therapies. The echocardiographic aspects of benign and malignant cardiac tumors described in this article, along with a clinical evaluation may orient the differential diagnosis and aid in choosing the further steps useful to define the nature of the mass.
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Affiliation(s)
- Paolo G. Pino
- Former Chief of Non Invasive Cardiovascular Diagnostics DepartmentOspedale San CamilloRomeItaly
| | - Antonella Moreo
- Cardiology IV, 'A.De Gasperis'DepartmentNiguarda Ca' Granda HospitalMilanItaly
| | - Chiara Lestuzzi
- Cardio‐oncological Rehabilitation Service, Azienda Sanitaria Friuli Occidentale (ASFO)c/o National Cancer Institute (CRO), IRCCSAvianoItaly
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Mishra R, Shemmeri E, Pani S, Tribble M. Primary cardiac sarcoma presenting with easy bruising: a case report. Eur Heart J Case Rep 2022; 6:ytac331. [PMID: 36131906 PMCID: PMC9486904 DOI: 10.1093/ehjcr/ytac331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/30/2021] [Accepted: 08/09/2022] [Indexed: 11/30/2022]
Abstract
Background Primary cardiac sarcomas are rare, aggressive types of malignancies with poor prognoses and can rarely present with thrombocytopenia. Sarcomas account for 65% of primary malignant cardiac tumours. Clinical symptoms often present with constitutional symptoms such as shortness of breath, weight loss, and fatigue. In addition, the tumour’s location determines treatment options and prognosis. Multimodal imaging facilitates the detection and assessment of cardiovascular tumours. This case study presents a rare primary right heart cardiac sarcoma presenting with thrombocytopenia. Case summary An 80-year-old male presented to the emergency department with complaints of worsening dyspnoea, ease of bruising, and chest pain. An extensive investigation into the cause of thrombocytopenia was performed. A transthoracic echocardiogram, computed tomography scan, and cardiac magnetic resonance (CMR) image revealed a large mass affecting the right atrium and right ventricle. Myocardial biopsy showed high-grade angiosarcoma. Due to his advanced age and intraventricular septal involvement of the mass, the multidisciplinary team decided to proceed with palliative chemotherapy. Discussion Many cardiac tumours remain asymptomatic, and the diagnosis is made at an advanced stage of the disease. Differential diagnoses of the intramural masses include haemangiomas, lipomas, rhabdomyomas, lymphomas, and sarcomas. Multiple treatment options should be considered to address thrombocytopenia. Tumour diagnosis and identification consist of laboratory tests and multimodal imaging. Complete surgical resection with neoadjuvant and adjuvant purposes is the mainstay of cardiac sarcoma therapy. A multidisciplinary, individualized care approach should be performed.
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Affiliation(s)
- Rina Mishra
- Department of Medicine, Albany Medical Center , 43 New Scotland Ave, Albany, NY 12208 , USA
| | - Ealaf Shemmeri
- Department of Cardiothoracic Surgery, Albany Medical Center , 43 New Scotland Ave, Albany, NY 12208 , USA
| | - Saroj Pani
- Department of Anesthesiology, Albany Medical Center , 43 New Scotland Ave, Albany, NY 12208 , USA
| | - Matthew Tribble
- Department of Anesthesiology, Albany Medical Center , 43 New Scotland Ave, Albany, NY 12208 , USA
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7
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Restivo L, De Luca A, Fabris E, Pagura L, Pierri A, Korcova R, Franzese I, Fiocco A, Rauber E, Mazzaro E, Bussani R, Belgrano M, Pappalardo A, Sinagra G. A 20-year experience in cardiac tumors: a single center surgical experience and a review of literature. J Cardiovasc Med (Hagerstown) 2022; 23:722-727. [PMID: 36166324 DOI: 10.2459/jcm.0000000000001375] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Cardiac tumors are rare and heterogeneous entities which still remain a diagnostic and therapeutic challenge. The treatment for most cardiac tumors is prompt surgical resection. We sought to provide an overview of surgical results from a series of consecutive patients treated at our tertiary care center during almost a 20-year experience. METHODS AND RESULTS In this single center study, 55 consecutive patients with diagnosis of cardiac tumor underwent surgical treatment from January 2002 to April 2021. Of these, 23 (42%) were male and the mean age was 62 ± 12 years. Fifteen (27%) patients were symptomatic at the time of the diagnosis, mostly for dyspnea and palpitations. The most frequent benign cardiac tumor was myxoma (32; 58%), occurring mainly in the left atrium (31; 97%). Pleomorphic sarcoma was the most frequent primary malignant cardiac tumor (4; 7%), mainly located in the ventricles (1; 25% in the left ventricle; 2; 50% in the right ventricle). In all cases of benign tumors surgery was successful with no relapses. Two (50%) pleomorphic sarcomas showed subsequent relapses. After a median follow-up of 44 months, 15 (27%) patients died. Although malignant tumors presented a limited survival, benign tumors showed a very good prognosis. CONCLUSION Cardiac tumors require a multidisciplinary approach to guarantee a prompt diagnosis and appropriate treatment. In our surgical experience, outcome after surgery of benign tumors was excellent, while malignant tumors had poor prognosis despite radical surgery.
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Affiliation(s)
- Luca Restivo
- Cardiothoracovascular Department, Division of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste
| | - Antonio De Luca
- Cardiothoracovascular Department, Division of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste
| | - Enrico Fabris
- Cardiothoracovascular Department, Division of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste
| | - Linda Pagura
- Cardiothoracovascular Department, Division of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste
| | - Alessandro Pierri
- Cardiothoracovascular Department, Division of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste
| | - Renata Korcova
- Cardiothoracovascular Department, Division of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste
| | - Ilaria Franzese
- Cardiothoracovascular Department, Division of Cardiac Surgery, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste
| | - Alessandro Fiocco
- Cardiothoracovascular Department, Division of Cardiac Surgery, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste.,Department of Surgical, Medical and Molecular Pathology and Critical Care, Division of Cardiac Surgery, University of Pisa, Pisa
| | - Elisabetta Rauber
- Cardiothoracovascular Department, Division of Cardiac Surgery, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste
| | - Enzo Mazzaro
- Cardiothoracovascular Department, Division of Cardiac Surgery, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste
| | - Rossana Bussani
- Pathology Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste
| | - Manuel Belgrano
- Department of Radiology, Azienda Sanitaria Universitaria Integrata and University of Trieste, Trieste, Italy
| | - Aniello Pappalardo
- Cardiothoracovascular Department, Division of Cardiac Surgery, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Division of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste
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8
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Sheth AR, Grewal US, Thotamgari SR, Shi R. Outcomes in patients with primary malignant cardiac tumors: A surveillance, epidemiology, and end results program (SEER) database analysis. J Card Surg 2021; 36:3463-3465. [PMID: 34091949 DOI: 10.1111/jocs.15725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Aakash Rajendra Sheth
- Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.,Department of Hematology and Oncology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Udhayvir Singh Grewal
- Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.,Department of Hematology and Oncology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Sahith Reddy Thotamgari
- Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.,Department of Hematology and Oncology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Runhua Shi
- Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.,Department of Hematology and Oncology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
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9
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Restivo L, De Luca A, Pinamonti B, Grilli G, Bussani R, Cominotto F, Crisafulli C, Dore F, Sinagra G, Pappalardo A. A case of primary cardiac sarcoma with an acute presentation: The role of multimodality imaging. Clin Case Rep 2021; 9:e04219. [PMID: 34178334 PMCID: PMC8212016 DOI: 10.1002/ccr3.4219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/08/2021] [Accepted: 04/12/2021] [Indexed: 11/12/2022] Open
Abstract
The case highlights the value of contrast echocardiography in raising clinical suspicion of malignancy, allowing a diagnostic work-up and the treatment of the primitive heart tumors.
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Affiliation(s)
- Luca Restivo
- Division of CardiologyCardiothoracovascular DepartmentAzienda Sanitaria Universitaria Giuliano‐Isontina and University of TriesteTriesteItaly
| | - Antonio De Luca
- Division of CardiologyCardiothoracovascular DepartmentAzienda Sanitaria Universitaria Giuliano‐Isontina and University of TriesteTriesteItaly
| | - Bruno Pinamonti
- Division of CardiologyCardiothoracovascular DepartmentAzienda Sanitaria Universitaria Giuliano‐Isontina and University of TriesteTriesteItaly
| | - Giulia Grilli
- Division of CardiologyCardiothoracovascular DepartmentAzienda Sanitaria Universitaria Giuliano‐Isontina and University of TriesteTriesteItaly
| | - Rossana Bussani
- Pathology DepartmentAzienda Sanitaria Universitaria Giuliano‐Isontina and University of TriesteTriesteItaly
| | - Franco Cominotto
- Emergency Medicine DepartmentAzienda Sanitaria Universitaria Giuliano‐IsontinaTriesteItaly
| | - Carmelo Crisafulli
- Nuclear Medicine DepartmentAzienda Sanitaria Universitaria Giuliano‐IsontinaTriesteItaly
| | - Franca Dore
- Nuclear Medicine DepartmentAzienda Sanitaria Universitaria Giuliano‐IsontinaTriesteItaly
| | - Gianfranco Sinagra
- Division of CardiologyCardiothoracovascular DepartmentAzienda Sanitaria Universitaria Giuliano‐Isontina and University of TriesteTriesteItaly
| | - Aniello Pappalardo
- Division of Cardiac SurgeryCardiovascular DepartmentAzienda Sanitaria Universitaria Giuliano‐IsontinaTriesteItaly
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